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New Coronavirus 'Eerily' Like SARS
Person-to-person transmission of the virus can take place in healthcare settings and can do so with "considerable morbidity."
By Michael Smith, MedPage Today
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WEDNESDAY, June 20, 2013 (MedPage Today) —The novel coronavirus outbreak in the Middle East is eerily similar to SARS, according to an expert who was part of a team studying a cluster of cases in hospitals in Saudi Arabia.
"This feels like SARS, it really does," said Trish Perl, MD, of the Johns Hopkins University School of Medicine.
"The illness pattern, the incubation period -- there are a lot of eerie similarities," Perl toldMedPage Today.
Perl was part of an international team, led by Ziad Memish, MD, of the World Health Organization Collaborating Center for Mass Gathering Medicine in Riyadh, that looked into a cluster of 23 cases in hospitals in the east of Saudi Arabia.
The bottom line, as they reported online in theNew England Journal of Medicine, is that person-to-person transmission of the virus can take place in healthcare settings and can do so with "considerable morbidity."
The virus, now dubbed MERS-CoV, is related to the virus that caused the 2002-2003 SARS outbreak -- both are coronaviruses and both lead to severe respiratory illness.
One key difference, Perl and colleagues noted, is that -- at least in the cluster they investigated -- the fatality rate was 65%, markedly higher than the 8% or so seen in the SARS outbreak.
On the other hand, that rate may fall if a large number of milder cases is detected, they noted.
An outside expert, David Freedman, MD, of the University of Alabama at Birmingham, toldMedPage Todaythat an open question has been whether MERS could spread within hospitals as easily as did SARS.
The current study, he said, shows "unequivocally" that it can.
The report comes as the World Health Organization is reporting a total of 64 laboratory-confirmed cases of infection with MERS-CoV, including 38 deaths.
Most reported cases have either occurred in the Middle East or have involved recent travel to the region. While cases have been seen as far away as England, most have been reported from Saudi Arabia -- 49 cases and 32 deaths.
The investigative team included infectious disease specialists experienced with the SARS outbreak, including Allison McGeer, MD, of Toronto's Mount Sinai Hospital, who was one of the healthcare workers who contracted SARS during the outbreak.
SARS was contained and eventually controlled by identifying cases vigorously and then isolating them to prevent transmission, Perl noted, and similar tactics -- when they were applied in Saudi Arabia -- appeared to have the same effect.
"In the hospital where they were doing it, it does seem to abort transmission," she said.
But the tactics require hospitals to be ready implement stringent precautions at the first suspicion of MERS, Freedman said.
The question "is going to be how quickly infection control can be implemented in hospitals with even a remote suspicion of cases coming in from the Middle East," he said.
The outbreak took place in three general hospitals in the city of Al-Hufuf and a referral center some 100 miles away, beginning April 4 and 5, when the first two patients -- dubbed patients A and B -- were admitted to hospital.
The researchers could find no epidemiologic link between them but subsequent analysis showed that patient A's infection led directly or indirectly to the remaining 21 cases.
The key may have been Patient C, who had been undergoing long-term hemodialysis, and was admitted to hospital April 6 in the room next to Patient A.
When Patient A developed a fever April 8, Patient C was still in the same room and developed fever himself 3 days later. He also had dialysis in the hospital's outpatient hemodialysis unit twice after the onset of symptoms.
Between April 14 and April 30, MERS was confirmed in nine more patients who were undergoing hemodialysis, including six who did so at times overlapping those of Patient C.
All told, Patient C appears to have transmitted MERS directly to seven people, six in the dialysis unit and one in the intensive care unit, the researchers reported, while other infected people had more limited transmission and some did not pass on the disease at all.
The finding is reminiscent of the so-called "super-spreaders" of SARS, who were markedly more infective than most patients, Perl toldMedPage Today.
The researchers found other similarities with SARS, including the incubation period, which appears to be 5.2 days -- close to the 4.0 days observed for SARS.
The so-called serial interval of infection -- the time between the onset of illness in a case patient and the development of ilness in a contact -- appears to be slightly shorter: a median of 7.6 days for MERS compared with 8.4 days for SARS.
- Fever and cough, in 20 patients each
- Shortness of breath in 11
- Gastrointestinal symptoms in eight
- 20 patients had abnormal chest radiographs
As of June 12, the researchers reported, 15 patients -- 65% of the cluster -- had died, six had recovered, and two were still in hospital.
The investigators identified 217 household contacts and more than 200 healthcare contacts; MERS symptoms developed in five family members, including three with laboratory-confirmed infection, and in two healthcare workers (both laboratory-confirmed).
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